Aetna
Commercial payer with yield below target and a recurring medical-necessity denial pattern. In notice window — renewal posture decision due before Aug 31.
Contract
Fictional demo contractContract
Fictional demo contractExtracted terms
Extracted — review- Apply medical-necessity policy per Attachment 3 (Attachment 3 · Per claim)Breached
- Pay per Attachment 1 fee schedule (Attachment 1 · Per claim)At risk
- Adjudicate clean claims within 21 days (§5.2 · Per claim)At risk
- 2025-11-01 — Annual fee-schedule update+1.9% blended
Vendor profile
- cheryl.ford@trh.example.org
- Phone
- (555) 0111
- Owner
- C. Ford, Managed Care Director
Fictional TRH-side owner — example address, 555 number. No public payer contacts are used.
A CVS Health company providing health benefits and health insurance plans through the Aetna group of companies, including Aetna Life Insurance Company and affiliates. source
- HQ
- 151 Farmington Avenue, Hartford, CT 06156 ↗
- Website
- www.aetna.com/about-us.html
- Reference
- About Us & Company Information ↗
Public background only. No TRH relationship, contract, or endorsement with this company is real.
Performance
Below target6-month trend. Period is chosen to suit this relationship's category.
Weighted scorecard
Weighted: 75Transparent weights (editable in the roadmap build). Each criterion shows target, actual, score, trend, source, and open exceptions.
Exceptions & evidence
3 openMedical-necessity denial pattern vs. Attachment 3 policy.
Radiology fee-schedule variance on advanced imaging.
Adjudication timing exceeding 21-day window.
Corrective actions
Archive-don't-delete: resolved items move to an archived status with their evidence intact — nothing is destroyed.